Last week I provided some context as to how Medicare was compelled to implement the new hospital readmission penalties.  With this rule change, they have created a great opportunity for skilled nursing facilities and medical model assisted living communities to improve their market position.

Last week I provided some context as to how Medicare was compelled to implement the new hospital readmission penalties.  With this rule change, they have created a great opportunity for skilled nursing facilities and medical model assisted living communities to improve their market position.

Skilled Nursing

If you operate a skilled nursing facility and already successfully engaged in short-term rehab, you probably have all, or almost all of what you need to make this happen.

 Here are two things that will complete your package:

1.  Create a system that will help you to identify residents who are at risk of being readmitted and take steps to mitigate that risk. INTERACT (Interventions to Reduce Acute Care Transfers) is without a doubt, the best set of tools available.  The best part is that the tools and systems are FREE.  (I will be doing an article on Interact in a few weeks.)

2.  Keep great statistics.  In order to become your hospitals best friend and trusted partner, you need to be able to tell a compelling story and that story needs to be backed-up with solid data.  You need to be able to demonstrate that when residents are transferred from the hospital to your facility/community they are substantially less likely to be readmitted than if they go to your competitors.

Assisted Living

The two things listed apply to assisted living.  Many of the INTERACT tools can be used or adapted to the assisted living environment. Perhaps even more fundamental is that you will need to make the decision to move toward a more medical model of care.  This means having nurses every day and perhaps around the clock.  It means having available, rehabilitation services, pharmacy services, x-ray and lab and in many cases, a better medical records system.  Finally, in order to do it right, you will need to have a physician or physician group who will see patients in your community.

Telling Your Story

First, don’t bother trying to tell your story to the discharge planners!  You are not solving their problem which is to free up hospital beds. Your story will not be compelling to them.   You need to be telling your story to the hospital administrator and/or the chief financial officer.  They will get it immediately.  It will not be easy to get that first appointment. If anything, hospital executives are better at dodging vendors than skilled nursing and assisted living administrators and executive directors.  Be persistent.  Find someone who can open the door for you.  This is a time to call in favors from people who can facilitate an introduction.

Medicare/Capitation

There are two basic ways that seniors pay for medical care.  Currently about 75% of seniors are enrolled in traditional Medicare which is a fee-for-service and DRG based (for hospitals) plan.  These patients are mostly beyond the reach of assisted living communities but are in the bullseye for skilled nursing. It is these patients that hospitals are particularly trying to keep from being readmitted. The other 25% of seniors are served through a variety of capitated payment systems.  This means the federal government pays a flat monthly fee per covered patient to a non-governmental organization.  That organization is then responsible for providing medical care for those member patients at a level that is at least equal to what traditional medicare provides. These residents are an ideal fit for Assisted Living.  Those healthcare organizations are charged with providing the best possible care for their members at the lowest cost.  When their members are discharged from an acute hospital they traditionally go home and receive home health services or to skilled nursing.  In many cases they could receive equal or better care in a medical model assisted living community and at a lower cost. The challenge is finding the right people in those payor organizations.  

They are not easy to find.  A good place to start would be contract rehabilitation providers that work in skilled nursing facilities and interact with payor case managers.  If you have a friendly relationship with skilled nursing facilities they may also be able to help.   This is an exciting and fluid time for senior housing.    Over the next few years we will begin to see more and more segmentation of the marketplace.  Those communities who are able to provide the highest levels of care and are able to document successful outcomes are the ones that be most profitable. Steve Moran

Reminder:  I will be presenting a webinar titled “5 semi-easy & Semi-Cheap things you can do to improve occupancy.”

Here are the details:

Date:  Wednesday, September 19 2pm ET. Cost:  Free Sponsor:  RetirementHomes.com Register Here 

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Finally: If you know anyone who is looking at emergency call systems I would appreciate the opportunity to talk with them about Vigil Health Solutions.